2017 Revised Classification of Seizures

The International League against Epilepsy (ILAE) is the world's main scientific body devoted to the study of epilepsy, and it has recently revised its classification of seizures. The changes will help make diagnosing and classifying seizures more accurate and easier. In this article, you'll find the new general outline and basic seizure classification. In the coming weeks, epilepsy.com will be updated to reflect the new classification to help users searching for both the older and newer terms.

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  • Nonepileptic events (also called nonepilepsy seizures) are not caused by electrical activity in the brain. 
  • One in six people also has epilepsy seizures or has had them in the past. 
  • Nonepilepsy seizures may be associated with psychological conditions or other physical problems. 

What are they?

Events that look like seizures but are not due to epilepsy are called "nonepileptic seizures." Some people prefer to use the term "events" rather than seizures. You will see the terms used interchangeably here. A common type is described as psychogenic (si-ko-JEN-ik), which means beginning in the mind. Psychogenic seizures or events are caused by subconscious thoughts, emotions or "stress," not abnormal electrical activity in the brain. Doctors consider most of them psychological in nature, but not purposely produced. Usually the person is not aware that the spells are not "epileptic." The term "pseudoseizures" has also been used in the past to refer to these events, but we prefer to avoid this term as it is not accurate and has a negative meaning. 

It's important to know that some seizures that are not epilepsy could be caused by other physical problems. These are nonepilepsy seizures too, but not caused by a psychological condition. Further testing is needed to find the exact cause so they can be treated properly.

Are they common?

Psychogenic nonepileptic events are common. About 20% of the patients referred to comprehensive epilepsy centers for video-EEG monitoring are found to have nonepileptic seizures. About 1 in 6 of these patients also has epileptic seizures or has had them in the past. Psychogenic nonepileptic events have been more widely recognized during the past several decades. They are most often seen in adolescents and young adults, but they also can occur in children and the elderly. They are three times more common in females.

What do they look like?

The events most often look like complex partial or tonic-clonic (grand mal) seizures. Family members report episodes in which the patient stiffens and jerks. Doctors rarely witness the actual event, so they are drawn toward the diagnosis of epilepsy. Often years can be spent trying to treat the spells as epileptic seizures without success.

How are they recognized?

Certain kinds of movements and other patterns seem to be more common in psychogenic nonepileptic events than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures, however, so having one of them does not necessarily mean that the seizure was nonepileptic. Video-EEG monitoring is the best way of diagnosing nonepileptic seizures. The doctor may take steps to provoke a seizure and then ask a family member or friend to confirm that the event was the same as the usual kind.

Can they be treated?

The good news is that psychogenic nonepileptic events can respond to treatment. A psychiatric evaluation helps sort out possible psychological problems and the types of treatment that may be needed. Being diagnosed with psychogenic seizures doesn't necessarily mean that a person has a serious psychiatric disorder. Yet treating the nonepilepsy or psychogenic seizures will involve treating whatever psychological problems may be present.

  • Sometimes the episodes stop when the person learns that they are psychological. Learning what the diagnosis means and what it doesn't mean is very important. 
  • Some people can learn how to control the events with behavioral techniques such as relaxation therapy or other forms of cognitive behavioral therapy. 
  • Some people have depression or anxiety disorders that can be helped by medication.
  • Counseling for a limited time is often helpful. Both individual and family therapy may be recommended.
  • People who have both epilepsy and psychogenic nonepilepsy seizures or events will require seizure medication as well as treatments for the psychogenic events.
Authored by: Orrin Devinsky, MD
Reviewed by: Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 1/2013
Ask the Experts Video Series

Patty Osborne Shafer RN, MN, associate editor and community manager for epilepsy.com, discusses nonepileptic events with Dr. Selim Benbadis, hot topics editor for epilepsy.com and director of epilepsy at University of South Florida in Tampa, and Lorna Myers PhD, director of the PNES Program from the Northeast Regional Epilepsy Group.

In the video, "Ask the Experts: Spotlight on Nonepileptic Seizures Part 1," our experts discuss what nonepileptic events are and how they are diagnosed.

 

In the part 2 video, our experts discuss treatment for nonepileptic events.

 

In the part 3 video, our experts discuss how to respond to nonepileptic events and how to find help.